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Aim: This critical review explores the current evidence underpinning eccentric exercise therapy in the treatment of subacromial impingement syndrome (SAIS). Method: A critical review method was used. Four large databases, CINAHL, MEDLINE, SportDiscus and Pubmed, as well as the PEDro and Cochrane electronic libraries were searched. The search terms ‘subacromial impingement’ or ‘SAI’ or ‘shoulder impingement’ and ‘eccentric exercises’ or ‘eccentric loading’ or ‘eccentrics’ were used. All available studies were marked against predetermined inclusion and exclusion criteria. Results: Five studies met the inclusion criteria, two of which were RCTs, one a case series, one a single subject A–B experimental design and one a pilot study. Similarities in the nature of the eccentric exercise programmes in these five studies included the exercise regime. Commonly, these studies’ exercise regimes followed three sets of 15 repetitions, twice each day for 2 months, and the resistance was either hand weights or resistance bands, and used the pain monitoring model as a measure of readiness to progress resistance. Main differences in the programmes were the arm position chosen for performance of the exercises and the shoulder muscle groups targeted. Conclusions: Although there is a clinical consensus, which would appear to support the above regime, there is limited empirical evidence. Therefore, more research on such areas as the best arm position and exercise regime is required. In addition, while the pain-monitoring model appears to be supported clinically; again, further empirical evidence is needed before it can be recommended as a means of monitoring readiness for exercise progression. More research is needed to determine the best arm position and exercise regime for optimum results.